甲状腺微小乳头状癌消融范围与消融能量的关系：微波消融与激光消融的比较。
The relationship between ablation range and ablation energy in papillary thyroid microcarcinoma: a comparison between microwave ablation and laser ablation.
机构信息
Department of Ultrasonography, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Changsha, 410013, Hunan, China.
Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
出版信息
Eur Radiol. 2024 Sep;34(9):6072-6081. doi: 10.1007/s00330-024-10636-4. Epub 2024 Feb 10.
OBJECTIVES
To study the relationship between the ablation range and applied energy of laser ablation (LA) and microwave ablation (MWA) in papillary thyroid microcarcinoma (PTMC).
METHODS
A total of 201 PTMC patients were treated with LA (n = 102) or MWA (n = 99) with single-applicator fixed ablation. The ablation range was determined by contrast-enhanced ultrasound. The ratios of ablation volume, longitudinal diameter, and orthogonal diameter to ablation energy (R, R, R) were analyzed and compared between MWA and LA. The effects of PTMC characteristics and Hashimoto's thyroiditis (HT) on ablation efficiency were evaluated by linear regression.
RESULTS
The R was 0.72 (0.65-0.84) mm/J for MWA and 0.48 (0.39-0.54) mm/J for LA. HT was significantly correlated with R of LA (coefficient = - 0.367, p < 0.0001). R did not differ significantly between MWA and LA (MWA 0.026 mm/J, LA 0.025 mm/J; p = 0.957). However, MWA had a greater R than LA (MWA 0.014 mm/J, LA 0.012 mm/J; p < 0.0001). The plateau values of MWA and LA on the ablation orthogonal diameter were 10.7 mm and 8.69 mm, respectively.
CONCLUSIONS
MWA showed a higher R than LA. More intuitively, MWA had a better ablation performance than LA on the orthogonal axis rather than the longitudinal axis. Theoretically, MWA and LA could achieve complete ablation of ≤ 6.70 mm and ≤ 4.69 mm PTMC separately by single-applicator fixed ablation considering a unilateral 2-mm safe margin. HT had a negative effect on LA but not on MWA.
CLINICAL RELEVANCE STATEMENT
This study establishes strong connections between ablation energy and ablation range in papillary thyroid microcarcinoma (PTMC) in vivo, possibly contributing to the supplementation of the PTMC Ablation Consensus or Guidelines and providing a scientific basis for choosing clinical ablation parameters in PTMC.
KEY POINTS
• Both microwave ablation (MWA) and laser ablation (LA) have excellent performance on the ablation longitudinal axis (easily exceeding 10 mm) for papillary thyroid microcarcinoma (PTMC). • MWA performed much better than LA on the ablation orthogonal axis. • MWA and LA are expected to achieve complete ablation of ≤ 6.70 mm and ≤ 4.69 mm PTMC separately by single-applicator fixed ablation considering a unilateral 2-mm safe margin.
目的
研究激光消融（LA）和微波消融（MWA）在甲状腺微小乳头状癌（PTMC）中的消融范围与应用能量之间的关系。
方法
共对 201 例接受单一消融探头固定消融治疗的 PTMC 患者进行研究，其中 102 例接受 LA 治疗，99 例接受 MWA 治疗。通过超声造影确定消融范围。分析比较 MWA 和 LA 之间消融体积、纵向直径和正交直径与消融能量的比值（R、R、R）。采用线性回归评估 PTMC 特征和桥本甲状腺炎（HT）对消融效率的影响。
结果
MWA 的 R 值为 0.72（0.65-0.84）mm/J，LA 的 R 值为 0.48（0.39-0.54）mm/J。HT 与 LA 的 R 值显著相关（系数为-0.367，p<0.0001）。MWA 和 LA 之间的 R 值无显著差异（MWA 为 0.026 mm/J，LA 为 0.025 mm/J；p=0.957）。然而，MWA 的 R 值大于 LA（MWA 为 0.014 mm/J，LA 为 0.012 mm/J；p<0.0001）。MWA 和 LA 在消融正交直径上的平台值分别为 10.7 mm 和 8.69 mm。
结论
MWA 的 R 值高于 LA。更直观地说，MWA 在正交轴上的消融性能优于 LA，而不是在纵向轴上。理论上，考虑单侧 2mm 安全边界，MWA 和 LA 可分别通过单一消融探头固定消融治疗实现≤6.70mm 和≤4.69mm 的 PTMC 完全消融。HT 对 LA 有负面影响，但对 MWA 没有。
临床相关性声明
本研究在体内建立了甲状腺微小乳头状癌（PTMC）中消融能量与消融范围之间的紧密联系，可能有助于补充 PTMC 消融共识或指南，并为 PTMC 临床消融参数的选择提供科学依据。
关键点
微波消融（MWA）和激光消融（LA）在甲状腺微小乳头状癌（PTMC）的消融纵向轴上（轻松超过 10mm）都有出色的表现。
MWA 在消融正交轴上的表现明显优于 LA。
考虑单侧 2mm 安全边界，MWA 和 LA 有望分别通过单一消融探头固定消融治疗实现≤6.70mm 和≤4.69mm 的 PTMC 完全消融。
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